1. Overview of concept of scaling-up George Laryea-Adjei UNICEF 21 July 2005

2. Focus of presentation The programming stage of policy process For PRSs that provide detailed information on the “how” – at the level of “strategies” and “actions” in PRSs + MTEF For PRSs that provide just a development framework - level of sector planning and MTEF

3. The case Several reforms to enhance delivery of basic services since 1990s: SWAPs, MTEF Protection/increase of expenditures on poverty reduction Earmarking/targeted approaches Decentralization (hybrid type in most cases) Yet, evidence of stagnating/worsening outcomes in several sectors/countries. E.g. under five mortality has gone up in some star Health SWAP countries with increased budgets; same for underweight, etc.

4. Expenditure tracking studies also show that bulk of resources does not always reach the intended beneficiaries Benefit-incidence studies show that the poor still receive disproportionately less public investment Many UN agencies with proven interventions are trapped in the pilot/small scale mode Therefore, greater focus on type + combination of interventions and how they are delivered Serious challenges with spending effectiveness and efficiency

5. Points to note Scaling up means reaching more people through national policy processes and mechanisms Scaling up does not mean reaching all at the same time The principles of strategic planning (not comprehensive planning) are most relevant: Have a “starting point” Develop a sequencing plan for other interventions Address all aspects of “starting point” (recurrent+development)

6. The approach For Goals/targets address: Policy issues Financing issues Better targeting of resources Scaling up (some) public investments: Scaling up (some) services Scaling up (some) systems development

7. Within public investments focus on: Within services/interventions: Proven high impact interventions/ cost-effective interventions Quick wins offer a starting point (MP identifies some; best if country and context specific) Within systems development: Consider institutional pluralism (community IMCI; ITNs) Greater decentralization (longer term)

8. Safe water Scaling up safe water provision in rural districts when there was no Agency for rural water: Service: out-door, small scale service Institutions: combination of local government teams, NGOs, CBOs, private contractors, women’s groups, national agency Capacity building was tied to specific products Result: dramatic increase in access to safe water in rural districts; pluralism reduced costs in a significant manner Sequencing: Local depts now being set up, sanitation and hygiene education being scaled

9. Lessons Useful to prioritise high impact interventions for goals/targets Do not concentrate actions in single depts, esp when capacity is weak Have a sequencing plan for scaling up interventions and systems support To guarantee scaling up, make sure to include intervention(s) in MDBS policy matrix and/or MTEF, in addition to annual sector plans and PRS Strategic, not comprehensive planning